New guidelines for diagnosis and management of acute coronary syndromes

The guideline establishes a new clinical standard for the diagnosis and management of acute coronary syndromes (ACS) in Australia. It replaces the 2016 guideline, representing the first major update in nearly a decade.

Main Recommendations

The new guideline features critical new information, including:

1. new terminology and revised definition of myocardial infarction;
2. electrocardiogram (ECG) patterns of acute coronary occlusion myocardial infarction (ACOMI), beyond ST-segment elevation;
3. use of clinical decision pathways incorporating high-sensitivity cardiac troponin (hs-cTn) assays for more efficient risk assessment;
4. stronger emphasis on the optimal timing of primary percutaneous coronary intervention in people with ST-segment elevation myocardial infarction (STEMI);
5. use of intravascular imaging-guided percutaneous coronary intervention in people with non-ST-segment elevation acute coronary syndromes (NSTEACS);
6. treatment guidance for specific groups, including those with cardiogenic shock, multivessel disease or spontaneous coronary artery dissection;
7. timing of platelet P2Y₁₂ inhibitor administration in STEMI and NSTEACS;
8. more detailed advice on post-discharge care, including cardiac rehabilitation and secondary prevention programs, medicine adherence strategies, vaccinations and screening for mental health conditions;
9. treatment algorithms to enable more tailored prescribing of antiplatelet and anticoagulation therapies;
10. new recommended treatment target for low-density lipoprotein cholesterol (LDL-C); and
11. new recommendations on select medicines including PCSK9 inhibitors, β-blockers and angiotensin receptor-neprilysin inhibitors.

Changes in Management as a Result of the Guideline

The new guideline introduces key practice changes including broader recognition of ECG patterns of ACOMI, integration of hs-cTn testing into clinical decisions pathways and selective use of intravascular imaging in NSTEACS. Updated P2Y₁₂ inhibitor timing, stricter LDL-C targets and PCSK9 inhibitor use support more tailored and evidence-based care in the secondary prevention of ACS.

Read the guideline summary in the Medical Journal of Australia.

The full guideline is available at www.heartfoundation.org.au/for-professionals/acs-guideline.